This is a description of the information on the PDF workpages.
You can ask an ACA Navigator for assisstance. For toll‑free calls and online chat: https://www.healthcare.gov/contact-us/ .
End of health-plan questions. You can return to first question or continue to the next worksheet.
Return to first question.
SECOND WORKSHEET (general information and instructions for using the third worksheet)
The page explains of some of the things you should know about health plans.
Plans often list drugs in three or more price tiers.
1. Generic drugs are less expensive even though they are identical to the original drug (for example, the generic alendronate and the brand-name Fosamax).
2. Discounted brand-name drugs (or brand formulary) are drugs the insurer can buy (and sell) at a lower price than a pharmacy can.
3. Brand-name drugs (or non-formulary) that are not part of the formulary may cost as much as they would at a pharmacy.
If some members of the household require more expensive treatments or drugs, you may be able to put them in a Gold or Platinum plan, and everyone else in a plan with lower premiums. Or you might have a separate plan for a child under 26 who is currently living in another county or state. The tax credit would be divided between the plans.
These are not included in your deductible, but ACA plans do count them as part of your out-of-pocket maximum. Other plans may not.
The ACA (and many other sources) define copays as fixed amounts ($15 for drug, say), but some plans list copays as percentages of whatever a charge may be (20% of the drug cost) or as coinsurance after deductible (which seems to mean that they treat copays as coinsurance). Ask the insurer.
These cannot be higher than the ACA limit, but some plans do have lower ones. Your deductible is part of your out-of-pocket maximum.
Some insurers have facilities in other states and some may cover you in other countries. See Other Covered Services in the Summaries of Benefits and Coverage. If you need to be covered, you should be able to buy travel insurance through a travel agent.
Marketplace plans meet ACA standards, but in the past insurers were largely unregulated, and some of them did things that are no longer allowed. To learn about reputations, see their Wikipedia page’s section on legal issues (it may have a different name). Also do searches to find out if they often lay off large numbers of providers.
Wikipedia list of U.S. insurers
insurance plan rankings by state
Ratings by magazines and nonprofit groups are usually based on statistics and visits to the facilities.
Patients’reviews usually focus on the food and rooms.
Hospitals that require the use of the World Health Organization Surgical Checklist have more successful surgeries.
Medicare’s Hospital Comparison page
Consumer Reports (subscription required)
Hospitals that use the World Health Organization Surgical Checklist
Many states offer plans from these non-profit insurers. They can charge less and provide good service because they don’t spend huge amounts on monumental buildings and large executive salaries.
Some plans require separate deductibles for each family member. They may also require separate deductibles for pharmaceuticals.
You can find this information in the Summaries of Benefits and Coverage.
The subsidies are included in the premium prices in these examples. The premiums plus the out-of-pocket maximum are the most your health insurance costs could come to during the plan year.
The next two sections list things you should take note of so you can compare plans. Each has fictional examples to give you an idea of what is being asked for.
The first is for a plan for one person.
The second is a plan for a family of three.
Return to the start of the third worksheet questions
This is the end of this page. You can return to:
The page you are on is located at: www.hypertext.org/ENGLISH/etc/three_sheets.html